Cervical Artery Dissection – Post Test

You receive a call from an ambulance en route to your ED with a 38-year-old man suffering from a headache and vertigo. You want to ask the crew for more information on the history to help assess whether this patient may have a cervical artery dissection.

Which question will be most useful?

In patients under 40 years who have had ischaemic strokes, cervical artery dissection is the cause in what percentage of cases?

The patient arrives. It transpires that he had a fall onto his head whilst skiing, one week previously. He has had a left sided headache since the fall, and developed vertigo two hours ago; but has had no neck pain. Your immediate concern is to exclude which of the following?

What would your initial investigation of choice be in a patient experiencing a headache and vertigo after a head injury?

The presence of which clinical sign would be most suggestive of a cervical artery dissection?

Which of the following most accurately describes the pathology of Horner’s syndrome associated with carotid and vertebral artery dissections?

Which investigation would you choose to look for a cervical artery dissection?

After imaging, your patient is diagnosed as having a vertebral artery dissection. He is otherwise fit and not on any medication. You decide to treat him with which of the following?

A 65-year-old man comes to the ED complaining of headache, neck pain and difficulty swallowing. He had fallen off a horse one week earlier, briefly losing consciousness and twisting his neck. At that time, C-spine x-rays and CT head were normal.

What is the least likely diagnosis?

A 45-year-old woman presents with a dense hemiplegia consistent with a stroke. She has a normal CT head and is a candidate for thrombolysis. You are concerned that she may have a carotid dissection because of her age.

Which of the following treatment options is most appropriate?